Substance Abuse/Addiction

Substance Abuse and Addiction

Substance Abuse and Addiction

subabuseIt has long been known that marriage (or other long-term, committed relationships) and substance abuse don't mix. Having a partner who drinks too much or uses drugs is very much like throwing a stone into a still pond: the effects ripple out and influences all that is near.

In the case of a partner who uses drugs or drinks too much, the effect is felt by his or her children, relatives, friends, and co-workers. However, many would argue that, aside from the abuser, the greatest price is often paid by the abuser's partner.


What are the costs?

Couples in which a partner abuses drugs or alcohol are often very unhappy; in fact, these partners are often more unhappy than couples who don't have problems with alcohol or other drugs, but who seek help for marital problems. As drinking or drug use gets worse, it starts to take more and more time away from the couple, taking its toll by creating an emotional distance between the partners that is difficult to overcome. These couples also report that they fight and argue a great deal, which sometimes can become violent. It is often the fighting itself that can create an environment or situation in which the partner with the drinking or drug problems uses these substances to reduce his or her stress. When the substance use eventually becomes one of the main reasons for fighting or arguing, what we see happen is a vicious cycle, in which substance use causes conflict, the conflict leads to more substance use as a way of reducing tension, conflict about the substance use escalates, more drinking or drug use occurs, and so on. Couples in which a partner abuses drugs or alcohol have a very difficult time getting out of this downward spiral; fortunately, we also know of proven ways to help these relationships and, in the process, help the substance abuser recover. So, if you or your partner is having a problem with alcohol or other drugs, there is hope.

When Drinking or Drug Use is Harming the Relationship

There are several tell-tale signs that drinking or drug use by a partner is causing harm to the relationship to the point that help from a treatment professional may be needed. The following are some of the common danger signals often seen in couples in which a partner has a substance use problem:

  • Many arguments about drinking or drugs use or things related to drinking or drug use, such as money problems, staying out late, not taking care of responsibilities in the home, and so forth
  • On different occasions, having to "cover" for a partner who has been drinking or using drugs too much by making excuses for him or her, such as reporting to a boss or co-worker that the substance user is "sick" and won't be at work as a result 
  • A partner reporting that he or she drinks or uses drugs to reduce tension or stress related to arguments and fights in the home about alcohol or other drugs 
  • Drinking and drug use is the only or one of the few things the partners like to do together 
  • Episodes of domestic violence, or "angry touching" by either partner when a partner has been drinking or using drugs 
  • Finding that one or both partners need to be drunk or high to show signs of affection or to talk about the problems in their relationship 
  • The relationship or family as a whole becomes isolated from friends and relatives to hide the drinking or drug problem

Although most couples will not show all of these danger signs, if even one of these is present in your marriage or relationship, it indicates that it may be time for you to "take stock" of the relationship and think about making it better. That is likely to mean that drinking and drug use will need to stop and the problems in the relationship will need to be identified and addressed. If you or your partner are showing signs of having a problem with drugs or alcohol and there are problems in the relationship, it is common to hope these things will take care of themselves over time. Unfortunately, that rarely happens. The better thing to do is to get treatment as soon as possible, or at least call and ask about treatments that may be available to you. If you don't, the problems are very likely to get worse.

Can Treatment Help?

There are many different treatments available that can be effective in reducing or eliminating problems with alcohol or other drugs. Some treatments involve individual counseling, others involve group counseling, and still others involve self-help meetings and support groups like Alcoholics Anonymous or Narcotic Anonymous. So, if you have a problem with drinking or drug use, it is worth it to enter treatment, not only for you, but also for your partner, children, friends, and others. If your partner has a problem with drugs or alcohol, getting him or her to enter treatment may be one of the best things you can do for him and your relationship.

But what if your partner has a drinking or drug problem, but does not want to go to treatment or seek help, because he or she does not think there is a problem or because he or she does not want to be involved in counseling? This is a very common problem. It turns out that alcohol and drug abuse treatment programs have help for concerned family members and work with this very issue. They can give you ideas and information on motivating your partner to consider getting help; these approaches are often very helpful in getting family members who are reluctant to seek help to ultimately enter treatment.

But What About Our Relationship?

Many treatments for individuals who have a problem with alcohol and other drugs will include the partner in some way. Research has shown that involving partners in the treatment at some point can be very important in helping the treatment succeed. It is also very important that the problems in the relationship be treated; these problems do not go away because the drinking or drug use has stopped. Many couples are both surprised and disappointed that they continue to have many fights and arguments after the substance abuse has stopped.

The important point here is substance abuse by a partner causes damage to the marriage or relationship and these problems need to be treated, too. If the issues in the relationship are not treated, they can set the stage for continued conflict and, in turn, relapse to drinking or drug use. Thus, lasting recovery from substance use depends, in part, on making the relationship better. Eliminating drinking or drug use is only the starting point; once sobriety is attained, a supportive caring relationship can be one of the strongest factors in making that sobriety last.

Nearly 12 million people suffer from sexual addiction in the United States. Due to the accessibility of sexual material available on the Internet, cable television and videos, these numbers are increasing. Despite common misunderstandings, this addiction is not simply about "too much sex."

Sexual addiction is a serious problem in which one engages in persistent and escalating patterns of sexual behavior despite increasing negative consequences to one's self or others. Like other addictions, these behaviors continue despite sincere and persistent efforts to stop. Some might not think sex can be addictive because there are no chemicals involved. However, the body produces many hormones and neurotransmitters during sex that produce the same chemical "high" as drugs or alcohol. Sex addicts, like other addicts, often have a background of abuse (sexual, physical, emotional) and/or neglect, and family histories sprinkled with numerous addictions.

Because of the denial and shame associated with sexual behaviors, it is only recently that the reality of sexual addiction has been acknowledged by those caught in its grasp or by treatment professionals. Since this problem was first addressed in 1983, some have argued that sexual addiction does not exist or is exaggerated. Nevertheless, acknowledgment of compulsive sexuality is growing, and more help is available today than ever before.

What are the signs?

When sex has become addictive, it is used compulsively to "numb-out," get a "high," or both. An indicator that sexual addiction could be present is if someone expresses concerns about the sexual behavior of a spouse or partner that is not a part of their relationship (like viewing pornography or visiting a strip club). Another sign is if sexual behaviors are kept hidden from a spouse or others. Additional questions to ask to help identify if sexual behaviors are part of a sexual addiction are:

  • Have you lost control over your sexual behaviors? Have you crossed lines you didn't think you would cross? Set limits on your sexual behavior that you have failed to meet?
  • Have you experienced negative consequences (such as the loss of a relationship, being less productive at work, or spent less time with family or friends) because of your sexual behavior? Or would you experience negative consequences if others found out about your sexual behaviors?
  • Have you tried to stop any sexual behaviors but eventually returned to them?

If a positive response is given to any of these questions, it is a good indication that the person has become sexually addicted, and further assessment by a marriage and family therapist or other professional specializing in sexual addiction treatment is recommended.

What are some behaviors associated with a sexual addiction?
  • Compulsive masturbation
  • Simultaneous or repeated sequential affairs
  • Pornography
  • Cybersex, phone sex
  • Multiple anonymous partners
  • Unsafe sexual activity
  • Partner objectification/demand for sex
  • Strip clubs and adult bookstores
  • Use of prostitution/escorts
  • Sexual aversion/anorexia
  • Frequenting massage parlors
  • Sexual paraphilias (a need for unusual sexual stimulation) and/or any sexually offensive behavior

What causes sexual addiction?

Compulsive behaviors (as listed previously) are often fueled by mismanaged anger or fears of intimacy, and have their roots in the sexual shame of one's family of origin. Incest, avoidance of sex education, double-standards, sexual secrets, or sexual acting out by a parent (such as affairs or pornography use) can all lay the foundation for later sexual compulsivity. Sexual acting out can be used for various reasons, including to medicate emotional pain, manage stress, or as a substitute for true intimacy.

As with other addictions, there is usually an escalation of these behaviors due to tolerance, as the addict continues to pursue the needed "high" and/or "anesthetic" regardless of the escalating costs. Unfortunately, many individuals struggling with sexual addiction do not seek help, due in large part to the high degree of shame associated with a problem in this area.

Getting Help

Treatment generally includes a combination of individual, marital, and group therapy. Key tasks for recovery include breaking through denial, learning about the addiction process, and establishing sobriety. These are not necessarily sequential and most addicts will begin working on several of these simultaneously during the initial phase of therapy.

Much of the work in these first tasks is designed to help establish stability for the addict and his or her family. For instance, it is not uncommon for the addict to continue to minimize or deny the extent, frequency and/or damage caused by the sexual acting out. Reading books on the topic, attending self-help groups with others facing the same addiction, or working on a sexual history can help the individual more fully recognize the need for help.

Establishing sobriety early on in treatment is a critical, yet often difficult task. Defining sobriety can be challenging because complete avoidance of all sexual behaviors is usually not the goal of treatment. Identifying the specific behaviors to be sober from is critical. In addition, addicts must recognize the people, places, emotional states, and relational dynamics that trigger them into the addictive process and which need to be avoided or more effectively managed. If one's primary form of acting out is via the Internet, computer usage can be limited to certain times or places, and filtering or monitoring software can be used. A detailed plan of action for recovery also needs to be created. This plan can be shared with one's partner or family as part of an overall process of restoring relational trust.

Group work is strongly recommended because it affords the recovering addict both support and accountability. Within 12-step groups, it is common to seek out a sponsor with whom one can work through the 12-steps and check-in regarding sobriety. Such groups often provide the added benefit of increased flexibility (more groups per week, different hours, locations, etc.) at no cost. This is particularly helpful when encouraging the addict to have daily contact with somebody regarding recovery, which is important during the initial phase of treatment.

Couples therapy is also an essential part of recovery. A spouse or partner may fail to see the need for his or her involvement. Initially, the goal of couples therapy is to stabilize the relationship and help the spouse work through the trauma they have experienced. The ultimate goal is to establish a desired level of intimacy, both sexually and non-sexually. An important goal is to help the couple restore trust in the relationship through a process of apology and forgiveness.

pokerWhile millions of people engage in gambling activities with few or no apparent problems, this is not the case for everyone. Approximately three to four percent of the population report some gambling-related problems, while one to two percent report serious gambling-related problems.

Furthermore, it is estimated that one problem gambler affects at least seven other people—spouses, children, extended family members, and friends. Problem gambling can hurt not only one’s finances, but one’s physical and mental health, as well as relationships.

When is Gambling a Problem?

Gambling is risking something of value on the outcome of an uncertain chance event. Gambling is not inherently evil or harmful. Many people find it an exciting way to socialize and relax. Gambling can take many forms, ranging from lottery tickets, bingo, horse betting, casino games, to slot machines and video lottery terminals. There is cause for concern if you or someone close to you show five or more of the following signs (according to the American Psychiatric Association’s Diagnostic and Statistical Manual):

  • Pre-occupation with gambling
  • Need to gamble with increasing amounts of money to maintain excitement
  • Repeated unsuccessful efforts to cut back or stop gambling
  • Restlessness or irritability when attempting to “cut back”
  • Gambling as a way to escape from problems or unpleasant feelings
  • After losing money, a gambler returns the next day in an attempt to win it back (“chasing” losses)
  • Lies or conceals truth about money and time spent on gambling to family members, significant others, and/or therapist
  • Has committed illegal acts such as forgery, embezzlement, fraud, or theft to finance gambling
  • Has lost or seen distress in a significant relationship, job, career opportunity, or education due to gambling
  • Relies on others to provide money to relieve a desperate financial situation caused by gambling
What are the Risk Factors for Problem and Pathological Gambling?

With many gambling formats now legalized, the risks inherent in the activity are often overlooked. Relationship problems, social isolation, chronic or overwhelming stress, life transitions, recent crises and setbacks, helplessness and hopelessness due to poor coping skills, traumatic events past or present, environmental factors and possible genetic influences can all make a person vulnerable to problem gambling. Problem gamblers often use gambling as an escape from unpleasant feelings of helplessness, guilt, depression, and anxiety. In addition, some individuals falsely believe that their own control, skill or luck at gambling will help them win regularly. Early big wins may also set up unrealistic hopes for further wins. A person may focus more on the wins while minimizing losses and distort the reality of the situation.

How Does Problem Gambling Affect Individuals, Couples and Families?

More than a family’s financial health is at stake when gambling problems enter the picture. The disclosure or discovery of the extent of losses is often sudden and devastating. This in turn takes a toll on the emotional and physical health of both gambler and spouse. In desperation, some problem gamblers resort to crimes such as forgery, fraud, theft, and embezzlement. Adolescent children of those with gambling problems are at increased risk of depressive feelings, conduct problems and gambling problems. As well, dealing with the secrecy and shame of gambling problems can increase familial stress and isolate the gambler and family from outside support. Depression, anxiety and substance abuse are often associated with serious gambling issues. Though difficult, speaking honestly and openly with a therapist knowledgeable about problem gambling can go a long way in turning things around.

What Kinds of Help are there for Problem Gamblers?

A professional trained in working with problem gambling and marriage and family therapy can help the gambler and spouse discuss the reality of their situation respectfully and in safety. Both partners are given the opportunity to express their individual feelings and perspectives. Referrals to a financial or debt counselor may be made to manage financial losses. Treatment for gambling can range from brief, gambling behavior focused interventions to more in-depth work on underlying issues that contribute to gambling behaviors. These include:

  • Workbooks to help stop problem gambling behaviors. Brief therapy can also help gauge the gambler’s readiness to change and help increase motivation by having the client weigh the costs and benefits of the activity.
  • Cognitive behavioral therapy (CBT) to help gamblers correct their misconceptions about their chances of winning or making money from gambling.
  • Couple therapy to help a couple improve communication and mutual understanding, shedding light on how relationship distress, present and past, have contributed to gambling as a way of finding relief.

Family members are one of the most precious assets as one goes through life’s ups and downs. Enhancing coping and communication skills, self and other awareness, mending broken relationships, and learning to regulate one’s emotions can bring life back on track. A person may discover that when better personal and relationship resources are used to navigate life’s challenges, gambling as a problem falls away.

Where Can We Find Help?

A licensed marriage and family therapist (MFT) with knowledge of problem gambling can be a very important resource to arrest problem gambling before it spins further out of control. Many individuals and couples have found the crisis of problem gambling to be an opportunity to look at issues they have neglected for a long time. Seizing this moment as an opening for growth and healing has brought hope and renewal to many who seek help.

alcholprobsIt used to be called alcoholism. Today we know better. We know that drinking problems do not come in one form, but can take any of a number of forms. Some people who abuse alcohol start drinking heavily early in life and develop longstanding dependence. Others start using regularly following a setback—such as losing a job, or losing a family member. Still others engage in binges that may last for days, but are spaced weeks or months apart.

Today we know a lot more about this syndrome, this set of different patterns that fall under the term Alcohol Use Disorders (AUDs). And, better still, we know a lot more about how to turn things around—to get things back on track. Alcohol Use Disorders come in two general forms, or levels: Alcohol abuse and alcohol dependence. Alcohol abuse refers to a problem pattern where the drinking interferes with work, school, or home life, as well as where the drinking is hazardous, such as in driving an automobile or operating machinery. Or, the problem may generate difficulties with the law, with the spouse or family, or in the social realm—such as getting into fights.

Alcohol dependence can include any or all of the above, but it is even more serious. The person may be unable to stop or control the drinking, even after trying. There may be "tolerance" (having to drink more and more to get the same effect), or "withdrawal" (having physical symptoms when drinking is stopped or decreased).

It is estimated that 13% to 16% of Americans develop dependence on alcohol at some point in their lives, and another 9% to 10% develop alcohol abuse. In other words, 22% to 26% of the population experiences this problem at least once. Further, the rate among men is twice that among women and has a much wider range of contributing factors.

Family and Personal Life

A third or more of American families are directly beset by an alcohol problem at one time or another. And the costs are enormous in terms of medical expenses, work difficulties, finances, and particularly, family relationships. When there is someone with an AUD in the home, and that person is drinking, everybody may want to lay low—to get out of the way. Or, maybe some feel like crying, while others are burned up with frustration. And that’s no way for a family to have to feel. Drinking problems take their toll not only on the drinker, but also on everyone else around. If you, or someone you care about, are showing the signs of alcohol abuse or dependence, it is important to get treatment as soon as possible, or at least to call. If you don’t, the situation will probably get worse.

What's Treatment All About?

In a given year, only about 10% of people with an active drinking problem get into treatment or self-help. This figure is all the more distressing in light of the fact that, for the vast majority of these people, treatment works. So it really is worth (a) entering treatment if you are the one with the drinking problem, or (b) getting your loved one or friend into treatment if you are a family member or friend.

A number of approaches have been demonstrated to be effective with people with AUDs. Some of them are more oriented to seeing individuals, some to meeting in groups, some to involving the family. The majority of programs combine these methods. There are two points that need to be emphasized here, however. First, research has clearly shown that family members and friends are very important in aiding a problem drinker in getting help. Second, the family can be extremely important in helping the treatment to succeed. Part of the reason for this is that, in almost every case, families are important to the person with the drinking problem, just as that person is important to the family. Therefore, the caring, creativity, and wisdom of the family can be put to use in helping to turn the situation around.

Family or couples therapy is an option for those who are dealing with alcohol use disorders. Therapy can help the users and their loved ones deal with the stresses of withdrawal, relapse, figuring out available treatments, and deciding on the best options. Other main roles of the therapist are to help people understand how the drinking affects the family and vice versa, and to help identify what led to the onset or relapse in drinking. A therapist can also collaborate with other professionals who are working with the family or couple around the problem.

Depending on the severity of the AUD, the person may have to be detoxified—"dried out." In most cases, this can be done on an outpatient basis with proper medical supervision. In some instances, the drinker may have medical or withdrawal problems that dictate admission to a hospital to detoxify, even if it is for only a brief period.

There are some medications that help a drinker to stay sober. Some, like Antabuse, cause a negative reaction in the body when the per-son drinks alcohol. When given, however, it is better to have a "significant other" such as a spouse involved to help with the regimen.

Usually, it is helpful to combine treatment with self-help approaches, such as Alcoholics Anonymous (AA), Rational Recovery (a non-spiritual counterpart to AA), or Moderation Management (which is more oriented toward greatly reduced drinking rather than total abstinence). These approaches have been shown, alone, to help many people, but at the very least help they can assist the overall treatment effort to be more effective. Family members can also be helped by Al Anon, Alateen (for youth), or Alatot (for kids) and has a much wider range of contributing factors.